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P115. Arthropathies associated to inflammatory bowel disease (IBD): A retrospective survey


S. Cardile1, A. Chiaro1, D. Comito2, I. Loddo2, C. Romano1

1AOU G.Martino, Pediatric Department, Messina, Italy; 2AOU G.Martino, Genetic and Pediatric Immunology, Messina, Italy



Background: Arthropathies are considered extraintestinal manifestations (EIMs) of the IBD and can be classified as pauciarticular and polyarticular peripheral arthropathy, and axial arthropathy (sacroilitis and ankylosing spondylitis). Joint involvement is the most common EIMs in children with IBD and may involve 7–25% of cases. Clinical manifestations can be variable and peripheral arthritis often occurs before gastrointestinal symptoms develop. EIMs are more prevalent in patients with Crohn's Disease. There is an association between gut inflammation and evolution of recurrent articular disease that coincides with a flare-up of intestinal disease. Association between genetic background and HLA-B27 status is less common in pediatric than adult populations. Early diagnosis of these complications may guide therapy and reduce risks of progression and complications.

Methods: We performed a retrospective survey in children with IBD to evaluate a prevalence of arthropathies and correlation with intestinal disease activity. Data was collected from January 2001 to December 2010 in 89 children (age 8–15 years) with IBD (34 UC, 55 CD). The diagnosis of IBD was done on the basis of the endoscopic and histological criteria, while rheumatological diagnosis was made according to the European Spondyloarthropathy Study Group (ESSG) criteria, validated also in children.

Results: In 9 cases (4 M, 5 F) (10%) was diagnosed joint involvement, 5 (56%) patients with UC and 4 (44%) with CD. The average age at IBD diagnosis was 13.1 years. In 6 patients (67%) arthropathy had preceded diagnosis of the IBD. In 4 (45%) patients was diagnosed peripheral arthropathy, 2 (22%) axial involvement, and 3 (33%) with both axial and peripheral involvement. In all patients, the course of the intestinal disease was not correlated with the joint involvement and activity. No difference in prevalence between males and females and only 3 patients was HLA-B27 positive. No patient had a need for biological therapy for control of joint symptoms and usually bowel disease remission was accompanied by the disappearance of joint symptoms.

Conclusions: Arthropathies may be considered the most frequent EIMs of the IBD also in children. There are no significant differences in prevalence between UC and CD and the course of joint disease is separate from the intestinal disease activity. The treatment of intestinal disease can to control even the progress of joint disease. Peripheral arthritis HLA-B27 negative is the most frequent arthropathy in children.